Painkillers May Worsen Headache After Concussion

by John Gever John Gever Deputy Managing Editor, MedPage Today
November 02, 2013

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

AUSTIN, Texas -- Too much pain medication may have been part of the problem for teens reporting chronic headache months after suffering concussions, researchers reported here.

Nearly half of adolescents with post-concussion headaches lasting 3-12 months showed either complete resolution of symptoms or a reduction to pre-concussion levels after discontinuing their analgesics, according to Geoffrey Heyer, MD, and Syed Idris, MD, both of Nationwide Children's Hospital in Columbus, Ohio.

The findings emerged from a retrospective chart review of 104 consecutive adolescent patients treated at Nationwide Children's for concussion. Of these, 77 reported chronic headache after the injury, and 54 of this group were deemed to have "probable" medication overuse headache.

Under the ICHD, medication overuse headache may be diagnosed in patients with frequent headaches (at least 15 days per month) that either developed or worsened while using headache medications such as over-the-counter or prescription analgesics. The diagnosis is considered "probable" if either such medications have not yet been withdrawn or if the headaches continued for up to 2 months after medications were stopped.

Resolution of headaches or reversion to an earlier pattern after medication withdrawal confirms the diagnosis. In contrast, if headaches persist for more than 2 months after medication withdrawal, medication overuse cannot be considered a cause.

Continued use of analgesics for headache despite lack of efficacy "can cause chronification of a headache syndrome," Heyer and Idris explained.

They conducted the records review to gain insight into the prevalence and risk factors for medication overuse headache in an adolescent cohort with concussion.

Across the group of 77 with persistent post-concussion headaches, 44 reported some type of regular headache prior to the injury and 26 had a history of migraine or probable migraine. Both of these were somewhat more common in the 54 patients with probable medication overuse headache than in the 23 without.

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